Skip to main content

Frontal, Frontotemporal, and Related Approaches

  • Chapter
  • First Online:
Plastic Neurosurgery

Abstract

The opening of scalp, muscle, bone, and dura is described for four representative frontal approaches: supraorbital, unilateral frontal, bilateral frontal, and transfrontal-subcranial. Each approach has its own technical details, set of plastic neurosurgical concerns, and risks for each type of tissue. Most complications result from the opening and restoration of fragments of bone. Complications related to the injudicious opening and restoration of skin and dura are less common. Frontotemporal approaches are described as a group, with respect to the making of durotomies and restoration of tissues. The special features of osteotomies for orbitozygomatic, orbitopterional, and orbitozygomatic approaches are described separately.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zador Z, Gnanalingham K. Eyebrow craniotomy for anterior skull base lesions: how I do it. Acta Neurochir. 2013;155(1):99–106. https://doi.org/10.1007/s00701-012-1552-5.

    Article  PubMed  Google Scholar 

  2. Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol. 2003;59(3):223–7. https://doi.org/10.1016/s0090-3019(02)01037-6.

    Article  PubMed  Google Scholar 

  3. Raza SM, Garzon-Muvdi T, Boaehene K, et al. The supraorbital craniotomy for access to the skull base and intraaxial lesions: a technique in evolution. Minim Invasive Neurosurg. 2010;53(1):1–8. https://doi.org/10.1055/s-0030-1247504.

    Article  CAS  PubMed  Google Scholar 

  4. Zumofen DW, Rychen J, Roethlisberger M, et al. A review of the literature on the transciliary supraorbital keyhole approach. World Neurosurg. 2017;98:614–24. https://doi.org/10.1016/j.wneu.2016.10.110.

    Article  PubMed  Google Scholar 

  5. Ormond DR, Hadjipanayis CG. The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Minim Invasive Surg. 2013;2013:296469. https://doi.org/10.1155/2013/296469.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Feinendegen DL, Tremp M, Roldan JC. Flat incision technique for reconstructive brow surgery: a wound healing model and clinical evaluation. Plast Reconstr Surg Glob Open. 2018;26(2):e1684. https://doi.org/10.1097/GOX.0000000000001684.

    Article  Google Scholar 

  7. Jho HD. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach. Minim Invasive Neurosurg. 1997;40(3):91–7. https://doi.org/10.1055/s-2008-1053424.

    Article  CAS  PubMed  Google Scholar 

  8. Kinnunen I, Aitasalo K. A review of 59 consecutive patients with lesions of the anterior cranial base operated on using the subcranial approach. J Craniomaxillofac Surg. 2006;34(7):405–11. https://doi.org/10.1016/j.jcms.2006.04.007.

    Article  PubMed  Google Scholar 

  9. Ciechomski J, Aufgang R, Villaneuva L, Demarchi V. Subcranial approach in pediatric craniofacial surgery. Craniomaxillofac Trauma Reconstr. 2010;3(4):231–6. https://doi.org/10.1055/s-0030-1268521.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Raveh J, Laedrach K, Speiser M, Chen J, Vuillemin T, Seiler R. The subcranial approach for fronto-orbital and anteroposterior skull-base tumors. Arch Otolaryngol Head Neck Surg. 1993;119(4):385–93. https://doi.org/10.1001/archotol.1993.01880160029006.

    Article  CAS  PubMed  Google Scholar 

  11. Kawakami K, Yamanouchi Y, Kawamura Y, Matsumur H. Operative approach to the frontal skull base: extensive transbasal approach. Neurosurgery. 1991;28(5):720–4. https://doi.org/10.1227/00006123-199105000-00014.

    Article  CAS  PubMed  Google Scholar 

  12. Parent AD, Das SK, Mallette RA, Haines DE. Significance of the lateral canthal tendon in craniofacial surgery. Pediatr Neurosurg. 1993;19(2):73–7. https://doi.org/10.1159/000120703.

    Article  CAS  PubMed  Google Scholar 

  13. Potgieter A, Marucci DD, Dunaway DJ. Transcutaneous reconstructive lateral canthal anchoring for craniofacial surgery. J Plast Reconstr Aesthet Surg. 2019;64(5):697–8. https://doi.org/10.1016/j.bjps.2010.09.008.

    Article  Google Scholar 

  14. Agarwal CA, Mendenhall SD 3rd, Foreman KB, Owsley JQ. The course of the frontal branch of the facial nerve in relation to fascial planes: an anatomic study. Plast Reconstr Surg. 2010;125(2):532–7. https://doi.org/10.1016/j.asj.2007.12.011.

    Article  CAS  PubMed  Google Scholar 

  15. de Divitiis O, Capone C, Somma T, Elefante A, Di Lorenzo P, Cappabianca P. Frontotemporal approach. In: Cappabianca P, Cavallo LM, de Divitiis EF, editors. Midline skull base surgery. 1st ed. Cham: Springer; 2016.

    Google Scholar 

  16. Kadri PA, Al-Mefty O. The anatomical basis for surgical preservation of temporal muscle. J Neurosurg. 2004;100(3):517–22. https://doi.org/10.3171/jns.2004.100.3.0517.

    Article  PubMed  Google Scholar 

  17. Spetzler RF, Lee KS. Reconstruction of the temporalis muscle for the pterional craniotomy. J Neurosurg. 1990;73(4):636–7. https://doi.org/10.3171/jns.1990.73.4.0636.

    Article  CAS  PubMed  Google Scholar 

  18. Ziccardi VB, Mu L, Schneider RE, Sanders I. Innervation pattern of the temporalis muscle. J Craniofac Surg. 1988;9(2):185–9. https://doi.org/10.1097/00001665-199803000-00019.

    Article  Google Scholar 

  19. Oikawa S, Mizuno M, Muraoka S, Kobayashi S. Retrograde dissection of the temporalis muscle preventing muscle atrophy for pterional craniotomy. J Neurosurg. 1996;84(2):297–9. https://doi.org/10.3171/jns.1996.84.2.0297.

    Article  CAS  PubMed  Google Scholar 

  20. Colby GP, Bydon M, Tamargo RJ. Pterional (frontosphenotemporal) craniotomy. In: Jandial R, McCormick PC, Black PM, editors. Core techniques in operative neurosurgery. Philadelphia: Elsevier Saunders; 2011. p. 4–12.

    Chapter  Google Scholar 

  21. Chaddad-Neto F, Campos Filho JM, Doria-Netto HL, Faria MH, Ribas GC, Oliveira E. The pterional craniotomy: tips and tricks. Arq Neuropsiquiatr. 2012;70(9):727–32. https://doi.org/10.1590/s0004-282x2012000900015.

    Article  PubMed  Google Scholar 

  22. Iaconetta G, Ferrer E, Galino AP, Ensenat J, de Notaris M. Frontotemporal approach. In: Cappabianca P, Iaconetta G, Califano L, editors. Cranial, craniofacial and skull base surgery. Milan: Springer; 2010. p. 39–59.

    Chapter  Google Scholar 

  23. Sughrue ME, Parsa AT. Frontotemporal craniotomy with orbitozygomatic osteotomy. In: Jandial R, McCormick PC, Black PM, editors. Core techniques in operative neurosurgery. Philadelphia: Elsevier Saunders; 2011. p. 90–6.

    Chapter  Google Scholar 

  24. Gonzalez LF, Crawford NR, Horgan MA, Deshmukh P, Zabramski JM, Spetzler RF. Working area and angle of attack in three cranial base approaches: pterional, orbitozygomatic and maxillary extension of the orbitozygomatic approach. Acta Neurochir. 2002;50(3):550–5. https://doi.org/10.1097/00006123-200203000-00023.

    Article  Google Scholar 

  25. Seckin H, Avci E, Uluc K, Niemann D, Baskaya MK. The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. Neurosurg Focus. 2008;25(6):E4. https://doi.org/10.3171/FOC.2008.25.12.E4.

    Article  PubMed  Google Scholar 

  26. Fox AJ, Tatum SA. The coronal incision: sinusoidal, sawtooth, and postauricular techniques. Arch Facial Plast Surg. 2003;5(3):259–62. https://doi.org/10.1001/archfaci.5.3.259.

    Article  PubMed  Google Scholar 

  27. Andaluz N, van Loveren HR, Keller JT, Zuccarello M. The one-piece orbitopterional approach. Skull Base. 2019;13(4):241–5. https://doi.org/10.1055/s-2004-817701.

    Article  Google Scholar 

  28. Spiriev T, Poulsgaard L, Fugleholm K. One piece orbitozygomatic approach based on the sphenoid keyhole: anatomical study. J Neurol Surg B Skull Base. 2016;77(3):199–206. https://doi.org/10.1055/s-0035-1564590.

    Article  PubMed  Google Scholar 

  29. Zabramski JM, Kiris T, Sankhla SK, Cabiol J, Spetzler RF. Orbitozygomatic craniotomy. J Neurosurg. 1998;89(2):336–41. https://doi.org/10.3171/jns.1998.89.2.0336.

    Article  CAS  PubMed  Google Scholar 

  30. Raza SM, Thai QA, Pradilla G, Tamargo RJ. Frontozygomatic titanium cranioplasty in frontosphenotemporal (“pterional”) craniotomy. Neurosurgery. 2008;62(3):262–4. https://doi.org/10.1227/01.neu.0000317402.46583.c7.

    Article  PubMed  Google Scholar 

  31. Cokluk C, Senel A, Aydin K, Rakunt C, Celik F. Reconstruction of burr hole by using autologous button-shaped graft harvested from inner table of craniotomy flap: technique ad clinical result. Minim Invasive Neurosurg. 2003;46(6):372–3. https://doi.org/10.1055/s-2003-812506.

    Article  CAS  PubMed  Google Scholar 

  32. Bowles AP Jr. Reconstruction of the temporalis muscle for pterional and cranio-orbital craniotomies. Surg Neurol. 1990;52(5):524–9. https://doi.org/10.1016/s0090-3019(99)00112-3.

  33. Winston KR, McBride LA, Dudekula A. Bandages, dressings and cranial neurosurgery. J Neurosurg. 2007;106(6 Suppl):450–4. https://doi.org/10.3171/ped.2007.106.6.450

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Youssef, A.S., Winston, K.R. (2023). Frontal, Frontotemporal, and Related Approaches. In: Winston, K.R., Ketch, L.L. (eds) Plastic Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-031-27872-3_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-27872-3_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-27871-6

  • Online ISBN: 978-3-031-27872-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics